J
Am Geriatr Soc 1994 Nov;42(11):1143-9
Age, race, and gender variation in the utilization of coronary artery
bypass surgery and angioplasty in SHEP. SHEP Cooperative Research Group.
Systolic Hypertension in the Elderly Program.
Bearden D, Allman R, McDonald R, Miller S, Pressel S, Petrovitch H.
Division of Geriatrics, University of Alabama at Birmingham 35294-2041.
OBJECTIVE: To assess variability in the use of coronary
artery bypass grafting (CABG) and percutaneous transluminal angioplasty
(PTCA) in the Systolic Hypertension in the Elderly Program (SHEP) cohort
with incident coronary heart disease (CHD) by age, sex, and race.
DESIGN: Retrospective analysis of a multicenter prospective
cohort study.
SETTING: Community-based ambulatory population in academic
centers.
PATIENTS: Among 4736 subjects initially enrolled in SHEP,
there were 432 incident cases of CHD, excluding those patients who experienced
rapid or sudden cardiac death.
MAIN OUTCOME MEASURE: Incident cases of CHD who underwent
CABG or PTCA.
RESULTS: Of those participants > or = 60 and < 75 years
of age, 7.3% underwent PTCA, compared with 3.9% of those > or = 75
years (P = 0.14). 15.4% of those < 75 underwent CABG surgery, compared
with 7.8% of those 75 and older (P = 0.018). When both of these endpoints,
CABG and PTCA, were combined, 22.4% of those < 75 underwent a procedure,
while only 11.7% of the older cohort did (P = 0.005). Twenty-six percent
of men underwent either CABG or PTCA, while only 9.1% of women did (P
< 0.001). Of those < 75 years of age, 31.1% of men and 12.3% of
women underwent CABG or PTCA (P < 0.001). In the 75 and older age category,
19.5% of men underwent these interventions, compared with 5.9% of women
(P = 0.005). Active treatment group was significantly associated with
decreased use of procedures in participants < 75 year old with CHD.
Race, activity limitations, number of comorbid conditions, education level,
marital status, employment status, and social support were not significantly
associated with CABG or PTCA use. When the variables studied were entered
into a logistic regression model, increased age and female sex remained
independently associated with decreased CABG and PTCA use.
CONCLUSION: In the SHEP trial older patients and women,
regardless of comorbid conditions, socioeconomic status, and social support,
underwent less intensive cardiovascular interventions than did younger
patients and men when they developed CHD.
Publication Types: Clinical Trial; Multicenter Study; Randomized Controlled
Trial
PMID: 7963199 [PubMed - indexed for MEDLINE]
